Doctor,
researcher and teacher, Wispelwey puts his students and patients
interests first

Doctor, researcher and teacher,
Wispelwey puts his students and patients interests
first

Photo
by Jenny Gerow

Wispelwey,
here conferring with students, is regarded as a gifted and
passionate teacher. But he worries that medical faculty are
not rewarded enough for teaching.

By Elizabeth Kiem

For
most doctors there is a seminal moment in which the medical mission
is made clear: an inspiring patient who overcomes great odds,
a miracle drug that grants quality of life to the terminally ill,
or a case that is clearly beyond the reach of modern medicine
but still within a physicians daily rounds. For Brian Wispelwey,
it was learning about a new deadly disease as a fourth-year medical
student.

AIDS
slapped me in the face and woke me up to what it meant to be a
physician, said Wispelwey, a professor of internal medicine
in the Division
of Infectious Diseases and the founder and director of the
Universitys AIDS clinic. We were all trained in a
technological era, so there was this scientific optimism that
we can cure all.

When,
in the late 1980s and early 90s, many of those optimists
were fleeing the AIDS clinics of New York and San Francisco in
despair over the diseases relentless death rate, Wispelwey
was having his epiphany. As a resident at Harvard Universitys
Deaconess Hospital, he began to realize that a cure might not
be in the cards. We dont cure much, he said,
but we try to prolong life and improve its quality. When
I realized were doing that, the goal became very different.

Wispelwey
chose to do a medical fellowship at U.Va. in 1986, when the infectious
diseases program was considered among the best in the nation.
But by 1988, when he was asked to stay on as a faculty member,
it was clear that the demographics of Central Virginia barred
the University from ever becoming a hotspot of AIDS research.

I
was told that it was academic suicide, because the numbers (of
AIDS patients) were so small, he recalled recently, but
that was my choice. I could have gone back to Boston  the
place where you would be front and center and handling clinical
trials. But the opportunity here was that I could emphasize the
things I wanted to emphasize from the ground up. And thats
where I succeeded.

Drawing
from his earlier experience at Harvard where he was among doctors
administering the first AZT trials, Wispelwey set up the Charlottesville
areas first AIDS clinic. In the 15 years since opening,
the clinic has helped more than 500 patients and their families
here and in Lynchburg with state-of-the-art care. In 1993, and
again in 96, U.S. News and World Report rated it among the
best clinics in the country.

He
also was the force behind a successful telemedicine program founded
to provide long-distance care to AIDS patients in eight Virginia
prisons. With his guidance, U.Va. joined a telemedicine consortium
two years ago to provide consultations for the government of South
Africa.

Professor
Gerald Mandell, who was chief of infectious diseases until last
November, saw Wispelwey as the perfect candidate to take over
U.Va.s fledgling AIDS program.

We
saw that he could function as a master clinician and teacher,
he said. He clearly had the ability to learn with the patients,
to be a compassionate provider and an outstanding teacher. And
I must say, its proved to be a wonderful decision.

Wispelweys
latest endeavor is to direct a joint venture with the Medical
Centers organ transplant program for people with infectious
diseases in need of liver or kidney transplants. Still in the
final phases of development, its unclear how many hours
this will add to Wispelweys calendar, already crowded with
teaching hours, hospital rounds and consultative commitments to
the hospitals antimicrobial surveillance team.

Arranging
his schedule to accommodate all these obligations is tricky, and
a major worry for the 47-year-old Wispelwey, who sees his colleagues
increasingly forced to abandon their low-earning academic pursuits
for more lucrative medical initiatives.

I
have a genuine concern about how were going to pay for the
commitment to teaching when everything else is being rewarded,
he said, as a prelude to a larger topic  the remuneration
system of academic medical centers. How do you (as a salaried
faculty member) bring in money? Mostly by seeing patients, doing
clinical activity or through research grants. The teaching allotment
towards one salary is relatively small.

The
result, said Wispelwey, is a lack of incentive for Medical School
professors to do what they were originally hired to do 
teach.

Michael
Rein, also a professor of infectious diseases, shares a secretary
with Wispelwey, as well as some of his anxiety about the changing
priorities of medical schools. Two hours a week with a small
group of students doesnt pay as much as two hours in the
cath lab or endoscopy suite, Rein said.

But
no one is complaining about the job Wispelwey has done in that
regard. His efforts as an educator earned him the Medical Schools
Dunglison Outstanding Teacher of the Year award from 1990 to 1993
 the same years he walked away with the Universitys
Attending Physician of the Year honor.

We
have a large faculty, Rein said. Its totally
not the case that by chance he would win that three years in a
row.

Jamison
W. Chang is a fourth-year medical student who met Wispelwey while
taking a required clinical medicine course two years ago. Last
year, and again this year, he had the opportunity to work side-by-side
with Wispelwey while doing an internal medicine clerkship. Chang
says he has seen enough of Wispelwey to know that he will be the
model for his own medical career.

He
clearly emphasizes to both his patients and those he teaches that
there is a point at which modern medicine cannot change the course
of illness, Chang said. It is at this point that he
emphasizes the need to place the patient in control. I
discovered from him that physicians can do a greater service to
their patients by honoring their wishes than by subjecting them
to every test and treatment that modern medicine has.

According
to Andrew Darby, also a fourth-year medical student, one of the
things that most distinguishes Wispelwey is the fact that he puts
the education of students and residents first. He is always
striving to ensure that we approach clinical problems rationally,
Darby said, and that we provide care that is not only optimal
by current standards but also the best for each person.

Last
year his students nominated Wispelwey for the Humanism in Medical
Education award. His candidacy was based on his strength as a
mentor and provider of compassionate care. It is an honor that
he holds above all the others, even the opportunity to be part
of breakthrough research.

I
see myself as a translator, Wispelwey said. You get
other peoples research, you translate it and bring it to
the bedside and to the student. The thing Id like to instill
in my students, is a broader sense of mission.